Nurses Compass
Drug Guide
Diazoxide Choline
Classification
Therapeutic: Antihypertensive, Hyperglycemic agent
Pharmacological: K-ATP channel opener
FDA Approved Indications
- Management of hypoglycemia caused by hyperinsulinism, including congenital hyperinsulinism
- Treatment of hypertensive emergencies
Mechanism of Action
Diazoxide opens ATP-sensitive potassium channels in pancreatic beta cells, inhibiting insulin release. It also causes vasodilation by relaxing vascular smooth muscle, thus decreasing blood pressure.
Dosage and Administration
Adult: For hypoglycemia: Initial dose typically 3-8 mg/kg/day divided into 3-4 doses. For hypertensive emergency: Dose varies; usually 2-8 mg/kg/day orally, titrated based on response.
Pediatric: Similar dosages as adults, adjusted by weight, for hypoglycemia or hypertension.
Geriatric: Use with caution; start at low end of the dose range due to increased risk of adverse effects.
Renal Impairment: Dose adjustment recommended; monitor renal function.
Hepatic Impairment: Use with caution; no specific guidelines, monitor hepatic function.
Pharmacokinetics
Absorption: Well absorbed orally.
Distribution: Widely distributed in body tissues.
Metabolism: Metabolized primarily in the liver.
Excretion: Excreted mainly in urine.
Half Life: Approximately 20-30 hours.
Contraindications
- Hypersensitivity to diazoxide or related compounds.
- Serious cardiac conditions without appropriate monitoring.
Precautions
- Can cause fluid retention; monitor cardiac status and fluid balance.
- Use with caution in patients with renal or hepatic impairment.
- May cause hyperglycemia; monitor blood glucose levels.
Adverse Reactions - Common
- Fluid retention and edema (Common)
- Hyperglycemia (Common)
- Nausea and vomiting (Common)
Adverse Reactions - Serious
- Heart failure due to fluid overload (Serious)
- Hematologic reactions such as leukopenia, thrombocytopenia, anemia (Serious)
- Hypertrichosis (Common)
- Hypersensitivity reactions (Rare)
Drug-Drug Interactions
- Insulin or other hypoglycemic agents (increase hypoglycemia risk)
- Corticosteroids (may counteract hyperglycemic effect)
Drug-Food Interactions
- None specific
Drug-Herb Interactions
- None well established
Nursing Implications
Assessment: Monitor blood glucose levels regularly, cardiac function, fluid status, and electrolyte balance.
Diagnoses:
- Risk for electrolyte imbalance
- Risk for fluid overload or hypoglycemia/hyperglycemia
Implementation: Administer medication with food or milk to reduce gastrointestinal upset. Monitor closely for signs of fluid retention or glucose abnormalities.
Evaluation: Assess blood glucose levels, fluid status, and blood pressure to evaluate effectiveness and adverse effects.
Patient/Family Teaching
- Take medication exactly as prescribed.
- Notify healthcare provider if experiencing signs of fluid retention, nausea, or hypoglycemia.
- Maintain regular blood glucose monitoring.
- Follow dietary and fluid recommendations provided by healthcare team.
Special Considerations
Black Box Warnings:
- Potential for myocardial ischemia and pulmonary hypertension in neonates and infants with congenital hyperinsulinism.
Genetic Factors: Not specifically impacted by genetic factors, but genetic forms of hyperinsulinism may influence treatment effectiveness.
Lab Test Interference: May interfere with blood glucose testing; inform laboratory personnel if necessary.
Overdose Management
Signs/Symptoms: Severe hypoglycemia or hyperglycemia, fluid overload, hypotension, tachycardia.
Treatment: Discontinue medication, manage blood glucose levels with IV dextrose, and treat fluid overload with diuretics if necessary. Supportive care as needed.
Storage and Handling
Storage: Store at room temperature, away from moisture, heat, and light.
Stability: Stable under recommended storage conditions.